Analyst, Benefit Configuration

Navitus Health Solutions is seeking a Benefit Configuration Analyst to join our team!

The Analyst, Benefit Configuration ensures efforts are in alignment with the Claim Adjudication Operations (CAO) team to leverage technology and process improvement for the purpose of meeting the business needs of Navitus customers, clients, members, and pharmacies by accurately administering benefits. The Analyst, Benefit Configuration configures benefits in the claim adjudication system based on specifications from internal customers and external clients. This role applies knowledge of highly diverse plan designs, formularies, and networks across multiple lines of business, ensuring that claims adjudicate accurately and timely.

The Analyst, Benefit Configuration must use sound business judgement and demonstrate the ability to continually prioritize tasks, as customer experience and client financials are directly influenced by their quality of work. The Analyst, Benefit Configuration will work closely with several Navitus departments including, but not limited to, Account Management, Provider Relations, Formulary Operations, and Information Technology to ensure Navitus is able to provide a versatile adjudication system that allows for various benefit designs and accurate claim adjudication to adapt to the continuous changes in the pharmacy benefit industry.

This position may include after-hour and/or weekend hours with other eligible team members depending on workload.

Is this you? Find out more below!

How do I make an impact on my team?

Completes scheduled and urgent benefit additions, terminations, and changes timely and accurately to prevent member access to care issues, missed performance guarantees and potential liquidated damages.
• Acquires and maintains a basic level of knowledge and interpretation of multiple adjudication system screens and functions on a field-by-field level to design both standard and custom configurations to meet client expectations.
• Complies with standards set forth regarding benefit design and configuration including HIPAA, NCPDP and Navitus internal business standards.
• Performs quality assurance peer reviews and uses sound business judgment and expertise to contribute toward the creation of root cause analysis of issues.
• Uses departmental workflow management, issue resolution and reporting tools for troubleshooting and responding to general customer questions and issue resolution requests.
• Supports internal customers by participating in client meetings, audits and new program implementations with other areas of the company, answering benefit setup questions and providing guidance to other areas and roles on the benefit configuration process.
• Adapts to industry changes and evolving technology, maintaining a basic level of understanding of both legacy and emerging products and systems.
• Independently assesses business needs and participates in process improvement, cost reduction and automation efforts.
• Contributes to the creation and ongoing maintenance of departmental training materials, work instructions and policies.
• Conducts system enhancement and regression testing of a low to moderate level of complexity for benefit configuration processes to ensure compliance with state, federal and client regulations/standards.
• Contributes to training and maintains a mentoring relationship with new and existing benefit configuration team members.
• Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
• Other duties as assigned.

What our team expects from you?

• Associate's degree or equivalent work experience required.
• Minimal experience and/or training to begin learning skills, systems, and processes of the role with ability to perform tasks with close supervision.
• Basic experience with Microsoft Office, specifically Word and Excel.

What can you expect from Navitus?

• Top of the industry benefits for Health, Dental, and Vision insurance

• 20 days paid time off

• 4 weeks paid parental leave

• 9 paid holidays

• 401K company match of up to 5% - No vesting requirement

• Adoption Assistance Program

• Flexible Spending Account

• Educational Assistance Plan and Professional Membership assistance

• Referral Bonus Program - up to $750!

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